by Steph Fowler
In reporting the heartbreaking and unexpected losses of David Bowie and Prince earlier this year, the media celebrated both artist’s contributions to music, artistry, and androgyny. However, while Bowie was revered for his ability to put out an album and two videos while courageously and privately battling cancer, Prince’s ability to continue creating music and entertain audiences despite struggling with chronic pain was framed as a secret drug addiction.
Before the cause of Prince’s death had even been confirmed, the media had crafted a narrative regarding his long-term struggle with hip pain, which was apparently a result of his enthusiastic performances and penchant for high-heeled shoes. Instead of finding it noteworthy that Prince’s sacrifice and dedication to entertaining his fans led him to face chronic pain, speculation swarmed about a pill addiction. When his cause of death was determined to be an overdose of an opiate medication, a man who had been known for being exceptionally private and living a “clean” lifestyle had these parts of his identity brutally scrutinized.
Headlines and stories contained attention-grabbing words: Secrets. Pills. Addict. While it’s possible that some of these may apply, there were other, possibly more accurate terms that were mostly absent from the dialogue: Debilitating pain. Pain management problem. Opiate dependence.
Lives Not Wholly Their Own — The Price Fame Takes on the Famous
The selection and omissions of terminology were not accidental. Likely since the dawn of journalism, provocative and sometimes fabricated headlines have been used to document the lives of celebrities. Now that our society has become enamored with reality tv, tethered to technology, and craves the latest information, our fascination with the lives of the famous has only increased. At a time when we insist on constant amusement, even the deaths of great artists are sensationalized for entertainment purposes.
Musicians seem to be under the microscope, with an added degree of interest in their outrageous lives. Sometimes it’s easy to forget that it’s not all glamour.
After a point, musicians’ time and creativity don’t belong to themselves anymore. There are demands from record labels, expectations from fans, hectic travel schedules, and public personas to maintain. Celebrities make many personal sacrifices with their relationships, privacy, and sometimes physical health. But no matter what’s happening in their lives, they are expected to be a source of entertainment; and if they are not entertaining enough, the media will create entertainment at their expense.
There is an acceptance, if not an expectation, that drugs and alcohol are part of the trajectory as musicians grow into rockstars. Yet, if they cross the narrow line from partying rockstar to out-of-control addict, they become fodder for comedians, are vilified by the press, and are deemed morally flawed by the public. The recent documentary “Amy” highlighted this mindset, showing several examples of how late night talk shows turned Amy Winehouse’s battle with alcohol and drugs into punchlines. Similarly, Whitney Houston was often ridiculed about her drug and alcohol abuse. When their addictions eventually took their lives, both of them had their talents diminished by the addict narrative. Unfortunately, they are not alone.
Private Pain, Possible Dependence
At the time of Prince’s death, many people reflected on his privacy. Unlike other celebrities who opted for homes in Hollywood or Manhattan, Prince lived in a suburb outside Minneapolis near where he grew up. He spent little time on the publicity circuit, and his rare interviews showed that while he was a charismatic entertainer, he was also a rather soft-spoken person. Prince was not eager to be in the spotlight unless he was on stage, and the fame seemed inconsequential to his passion for music and entertaining audiences. This may be why he sought some sense of privacy while being part of an industry which consistently pushes the boundary between an artist’s personal and professional life.
This privateness certainly made his death more shocking because so few people knew that he had been struggling with pain. Even those closest to him in his last days said that he did not disclose the extent of his pill use or his pain.
Though his privacy had been long understood as part of his lifestyle, it was almost immediately criticized after his death and presented as his secret struggle with addiction. People questioned why he hadn’t sought help with his chronic pain or his media-diagnosed addiction. Aside from his established inclination for solitude, there are a number of possible factors that could have influenced his decision to keep his health concerns private.
Addiction is still not understood by many as a disease, and people who struggle with drug or alcohol problems regularly have their stories re-written by others. Complex identities are simplified to labels of “addict” or “junkie”.
Judgments are made about those with addictions regarding their inability to control themselves, including disparagement for their “weakness” for not being able to stop or reduce their use. This scrutiny is amplified for celebrities. References to artistic abilities and musical genius are replaced with stigmatizing, career-altering labels. The media capitalizes on the tragic demise of stars, and fans can lose sight of the celebrity’s talent and humanity. And while battles with some chronic or reoccurring diseases, such as cancer or multiple sclerosis, are seen as brave, an ongoing battle with the disease of addiction is often viewed as a series of failed attempts to address a personal or moral shortcoming. It should be no surprise that people, especially celebrities, would choose to avoid these characterizations by keeping concerns to themselves.
These dynamics played out as Prince’s death was announced to the world, before his cause of death had even been determined. Instead of attempting to understand or waiting for more information, journalists and fans alike speculated, labeling Prince as an addict. Aside from the fact that HIPAA laws (U.S. medical privacy laws) were likely broken when information was leaked about Prince’s emergency medical treatment the week prior, many physicians were giving their opinions in interviews and diagnosing Prince, presumably without treating him as a patient, which is unethical. The addict label was being inappropriately used by many professionals and flippantly repeated by the media and fans despite the fact that addiction is still widely misunderstood, including within the medical field.
It’s generally understood that use of a medication does not mean it is being abused. What people may not know is that opiate painkillers were originally intended for short-term use. One myth that still exists is that if someone simply takes a prescription painkiller without abusing it that they will never develop a problem. In reality, the long-term use of an opiate medication, even if taken exactly as prescribed by a physician, can still cause a patient to develop a tolerance (needing more of a substance to get the same effect) and/or a physical dependence on the substance. If physical dependence occurs, stopping an opiate medication or even cutting back can cause withdrawal. Because withdrawal can be severe in many cases, detox under medical care is advised.
There are additional misconceptions about addiction that should be clarified. The first is that while addiction is a disease, “addiction” does not exist at a diagnosis. Instead, people are diagnosed with a “substance use disorder” which can vary from mild to severe depending on their symptoms. Second, it is important to understand that substance use disorders are legitimate and treatable medical conditions that occur among all ages, ethnicities, and social classes. Third, and surprising to some people, a substance use disorder or physical dependence on a medication does not always mean addiction. Addiction is typically characterized by a psychological dependence on a substance, compulsively seeking and using the drug, or continuing to use it despite having negative effects or consequences. While some people may become physically dependent on a substance with long-term use, not all of them will reach a point of addiction.
In Prince’s case, it has been established that his death was due to “fentanyl toxicity”, or an overdose. Opiates are used to control pain, and fentanyl is a very strong medication, between 50 to 100 times more potent than morphine and 30 to 50 times more potent than heroin, which is also an opiate. It is feasible that Prince could have been treated for his hip problems over a long period of time and eventually required a stronger medication to manage his pain due to tolerance. And while it is possible that he may have had a diagnosable opiate use disorder, this diagnosis by itself is also an oversimplification that dismisses the important matter of Prince’s chronic pain that also needed to be addressed.
Chronic pain is difficult to address with opiate dependence
Chronic pain is often an invisible disability that can be caused by a number of conditions and injuries, and it can range from annoying to completely debilitating. The need to manage pain adds complexity when addressing physical dependence on opiate painkillers. While withdrawal symptoms from the medication can be reduced through medical treatment, it can be difficult to find a new treatment that still makes the pain manageable. This difficulty has led to a somewhat polarizing debate as the stakes are increasing.
Although Prince’s death got a lot of attention, there have been an increasing number of opiate-related deaths and growing rates of opiate dependence, due in part to these medications being used long-term. A month before Prince’s death, one of the two major United States federal government agencies for health-related matters, the Centers for Disease Control and Prevention, announced new guidelines for the prescription of opiates, specifically noting that care should be taken in cases of treating long-term and chronic pain. While these new guidelines were a relief to many professionals in the field, others expressed concern that patients may not have their pain treated effectively.
As it stands, effective treatment for chronic pain without opiates can still be elusive, even for celebrities. In Prince’s case, it has been reported that he declined surgery at one point because blood transfusions are not an accepted practice for a Jehovah’s Witness. Even without such restrictions, there are still several barriers to finding alternative relief from pain. It can sometimes be difficult to find a specialist who understands the source and type of pain being experienced. Even if it is properly understood, there can be trial and error with surgery or other therapies, whereas the opiates provide immediate relief. While celebrities may not have to struggle with the financial cost of treatment or insurance limitations, someone like Prince may wish to avoid receiving treatment or having surgery simply because of the media attention and public curiosity about their health.
Another possibility is that Prince did seek care but was treated differently due to his fame, something known as VIP syndrome, which has been named as a contributing factor in Michael Jackson’s death. While people may assume this involves a celebrity demanding special treatment, it can also result from a doctor not wanting to inconvenience a revered person with time-consuming or personally invasive treatments for fear of burdening or embarrassing them. While a physician’s intent may be to make things easier for someone who already faces a lot of demands, it can result in broken protocols or missed ailments with potentially dire consequences. This is yet another way that fame can have unexpected and unintentional consequences on someone’s life.
There is still much that is not known about Prince’s medical condition or how his chronic pain was being treated, and there may never be anything but speculation about what actually led up to his death. However, medical professionals have used Prince’s death as an opportunity to highlight how these medications have been misunderstood and overprescribed for too long and to call for the end of prescription mismanagement to save lives.
What made Prince so phenomenal was that he was a quintessential entertainer, so much so that he subjected his body to such demands that he developed chronic pain. He likely downplayed this pain for a number of reasons, including possibly for his fans so as to not diminish their experience. His longstanding desire for privacy may have also led to him suffering alone, not only with pain, but also a possible dependence on the only thing that relieved it.
Musicians should leave their legacies through their music, instead of clickbait headlines and myths about addiction.
In order for this to happen, there needs to be an understanding that both chronic pain and substance use disorders are diagnosable medical conditions that are complicated but treatable. They need to feel like they can seek help, which means not stigmatizing treatment, not prying into their lives, and not filling in the gaps with information to sell articles.
During Prince’s career, he blurred lines, challenged gender roles, and developed new sounds. His lyrics included explicit sexual details, referenced God and faith, and addressed race and politics. He boldly confronted things that others wouldn’t dare. Hopefully, even in death, he will continue to do break down barriers so that there will be a better understanding of chronic pain, substance use disorders, and the humanity of our idols.
Steph Fowler, M.Ed., LCPC, CADC is a certified drug and alcohol counselor and clinical therapist focused on identity and narrative therapy. She is also a mental health educator, writer, and consultant.
Photo: Ann Althouse/Flickr